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More war vets bring disabling stress home

When he closes his eyes, Edmond Rivera can smell the burning flesh of his fellow soldier. He can see the man -- his friend -- clawing on the driver's-side window of his Humvee, trapped by flames after a bomb set his vehicle afire on an Iraqi roadside.

Though Rivera struggled to save his friend, he couldn't get get into the vehicle. All he could do was stand in the road and listen to the screams.

"You're two feet away from someone, watching the flesh melt off his bones, and there's nothing you can do about it," Rivera, 43, said of an experience now seared into his memory. "You can't forget."

Though he returned from Iraq more than two years ago, Rivera said his dreams -- and indeed, his waking life -- still are haunted by that image, and by memories of his own vehicle being twice damaged by explosions while he served as a squad leader in a military police platoon.

Now, the career military man fears driving on Louisville's highways. On the Fourth of July, he goes from window to window to make sure fireworks and firecrackers aren't bombs or gunshots.. And he tries to stay in his Louisville home as much as possible because it's the only place he feels safe.

Like nearly one out of every five Americans who have served in Iraq and Afghanistan, Rivera has post-traumatic stress disorder. And like many others, he experienced delays getting it diagnosed and now faces the possibility of redeployment that doctors say could worsen his condition.

As the number of Iraq and Afghanistan veterans with the disorder grows -- some expect it eventually will exceed the 19 percent rate among Vietnam veterans -- military and veterans hospitals across the nation say they have placed greater emphasis on screening for and treating PTSD.

"No military in the history of the world has done more to identify, evaluate, prevent and treat the mental-health needs and concerns of its personnel," said Department of Defense spokeswoman Cynthia O. Smith.

Yet there is evidence that screening has had spotty results, and many veterans still aren't getting the early care that experts say can greatly improve their chances of living a normal life.

A Defense Department task force report released this month calls for a greater focus on prevention and screening for the disorder but acknowledges that the military's mental health system doesn't have enough money or staff to meet future needs. Smith could not say how much is being spent on PTSD, saying officials are analyzing that now.

And the Government Accountability Office reports that only 22 percent of military members screened and found at risk for PTSD were referred for further evaluations.

Some, like Rivera, say they didn't receive any PTSD screening from the military. Rivera was diagnosed only after his girlfriend insisted he go to the Veterans Affairs Medical Center in Louisville almost two years after returning to the United States.

A couple of weeks ago, Rivera, an Army reservist, got orders to spend 179 days in Honduras, training local fighters. He figures the Army doesn't know about his disorder, since it was diagnosed by the VA hospital, not military doctors.

But PTSD doesn't automatically disqualify someone from being redeployed, even though many psychologists, including some within the military, liken it to reinfecting a psychological wound.

Rivera is fighting his potential deployment, saying he just wants to stay home and heal.

"I feel like I've served my time," he said. "Peace is all I want."
Flashback to attack

As Rivera was driving down the Watterson Expressway with his girlfriend two months ago, an empty box flew up from the road and hit his windshield. He doesn't remember the rest of the drive, only that it was fast, and that he walked around a Harley-Davidson dealership for 3 ½ hours afterward, decompressing.

His girlfriend, Gail Bratcher, took the wheel on the way home, while he reclined the passenger seat so he wouldn't have to look out the window.

Mentally, he said, hitting the box took him back to an incident in Iraq three years earlier, when he was an Army staff sergeant, sitting in the passenger seat of a vehicle traveling with a convoy of fuel trucks. The road was nicknamed "IED Alley," referring to the improvised explosive devices used by insurgents in Iraq.

An explosion threw a piece of asphalt onto the vehicle's hood, he said, bringing him "from calm to 1,000 degrees in a split second." Rivera, an amateur photographer and videographer, captured the blast on video.

The camera also was rolling a month later, when the hastily repaired vehicle -- with the words "Ed's Ouchy" scribbled on the front -- drove near another IED. That one cracked the windshield and sent a 30-foot plume of smoke into the air. It also damaged the hearing in Rivera's right ear, he said, and left shrapnel in the face of another soldier.

After returning to the United States in December 2004, Rivera said, he found himself instinctively searching roadsides for discolorations or strange objects that could be explosives. He looked for phantom shooters on overpasses. His girlfriend took over most of the driving.

As the months passed, Bratcher said, she watched her once fun-loving boyfriend -- a man who traveled the globe during his 23 years in the Army and as an active reservist -- retreat.

Six months after getting back from Iraq, he reluctantly returned to his human resources job with the Army Reserve, but commuting proved harrowing, and when he got home, he usually stayed there.

He lost interest in chess, golf, even photography. At night, he often woke up in a cold sweat, and Bratcher would sometimes catch him looking out windows, "checking the perimeter."

When she tried to comfort him or cuddle, he wouldn't let her get too close.

"He was the same person," Bratcher said, "but yet he wasn't."

"I didn't know how to feel," Rivera said.

Rivera was suffering classic symptoms of PTSD -- flashbacks, sleep problems, emotional numbness, jumpiness and hyper-vigilance. Some experts say it's not surprising so many Iraq veterans suffer from the disorder, given the constant stress of close combat and a largely hidden enemy.

Experts also say doctors are better at recognizing the disorder than they were years ago, which may account partly for the high numbers of affected Iraq veterans.

In Rivera's case, Bratcher wasn't sure what was wrong, only that he needed to be checked. In November of last year, VA hospital doctors diagnosed him with PTSD and depression.
Screening, treatment

Psychologists say delays in diagnosing PTSD increase the possibility of serious problems, such as depression, substance abuse and even suicide. Ideally, anyone experiencing symptoms for three to four months should seek treatment, say those who work with PTSD patients at the Louisville VA hospital.

But that often doesn't happen, for a number of reasons.

For one thing, veterans who returned from Iraq or Afghanistan before the end of 2003 didn't necessarily get screened. After that, the Department of Defense went national with a post-deployment health assessment that includes four PTSD questions.

Bob Wolz of Rineyville, Ky., for example, said he got no screening when he returned from Iraq in September 2003 to Fort Hood in Texas.

But even some soldiers who returned after that didn't get screened. Officials at Fort Knox's Ireland Army Community Hospital said they started offering the screening in October 2004. And Rivera said he got no screening when he returned from Iraq to North Carolina in December 2004.

Carl Mumpower, a North Carolina psychologist and national expert in PTSD, said the military recently has gotten better at ensuring that all returning soldiers are screened.

In addition to offering mental health care in Iraq, defense officials said, screenings are now offered within a week of a soldier's return, and then reviewed with a medical provider. A second screening, added nationally last year, is given about three to six months later.

Screening, however, doesn't always lead to treatment, according to the federal GAO.

Agency reports from this year and last showed that a relatively small percentage of military members found to be at risk for PTSD were referred for further evaluations: 23 percent in the Army and Air Force, 18 percent in the Navy and 15 percent in the Marines.

Officials could not provide comparable local figures, but Rogers, at Fort Knox, said medical professionals virtually always refer soldiers for further care if they suspect a problem.

One additional problem is that soldiers sometimes choose not to follow up. The defense task force's preliminary report noted a stigma surrounding mental health problems, which military officials are trying to address.

"They're concerned it will hurt their military career," Michael Hollifield, an associate professor of psychiatry and family medicine at the University of Louisville, said of soldiers. "And there's this thought that people fake it."
New tour possible

According to a November memo from the assistant secretary of defense, psychotic and bipolar disorders automatically disqualify someone from being redeployed by the military -- but PTSD does not.

The memo calls the disorder treatable, although it says the potential for effective treatment is considered on a case-by-case basis that takes into account the soldier's vulnerabilities and demands of the job.

If soldiers are diagnosed outside the military health system, such as at a VA hospital or a family doctor's office, it's up to them to raise the issue -- although officials say they are working to share medical records more easily between the military and Veterans Affairs.

At Fort Knox, Army reservists treated elsewhere and ordered to redeploy must let their commanders know of their diagnosis, said Col. Susan Rogers, a psychologist and behavioral health chief at Ireland Hospital. Even if they don't initially, it should come up during the pre-deployment process, when soldiers are asked whether they got mental health care during the previous year. And those with mental health concerns or a history of receiving care are evaluated for their fitness to redeploy.

Army officials did not respond to repeated requests for the number of soldiers with PTSD who are now deployed. But several psychologists, including Rogers, said they think that number should be zero.

"I would never recommend that," Rogers said, adding that soldiers shouldn't be drummed out of the military for having the condition, but should be directed to appropriate military jobs in the United States.

Redeploying those with PTSD " absolutely makes no sense. It's asking for disaster," said Lebanon, Ky., psychiatrist James Bland, who has treated recently returned soldiers with PTSD. "It's like sending someone who had a heart attack back to dig ditches. They might last a while, but they may die."

Irv Mattingly, a Vietnam veteran diagnosed with PTSD who now works with the Kentucky Disabled Veterans Outreach Program, said deploying troops with the disorder could also endanger others.

"Would you like to be in that foxhole with someone who has PTSD?" he asked.

Rivera, for his part, said he has informed Army officials he doesn't want to go to Honduras and is awaiting a response. He said he dreads the idea of driving around the country and the even remote possibility of facing combat. "I just don't want to get shot at," he said, adding that he wants to find a civilian job and retire from the military.

In the meantime, he said, he continues to work to exorcise the demons of war with therapy at the VA hospital, weekly support groups and the anti-depressant Zoloft.

"I live minute by minute, day by day and just hope nothing goes 'boom,' " he said. "When you see the things I've seen and had to do the things I've done, you don't forget."

WASHINGTON — In the three months after Marine Maj. John Ruocco returned from Iraq feeling numb and depressed, he couldn’t sleep. He had lost weight. He had nightmares. He was distracted and withdrawn from his two young sons.

One night, he promised his wife, Kim, that he would get help. The next morning, he was dead. The 40-year-old Cobra helicopter pilot, based at Camp Pendleton, Calif., had hanged himself.

There are others. Army reservist Joshua Omvig. Army Capt. Michael Pelkey. Marines Jonathan Schulze and Jeffrey Lucey. Each came home from tours in Iraq and committed suicide.

Veterans’ groups and families who have lost loved ones say the number of troops struggling with post-traumatic stress disorder or other mental health issues is on the increase and not enough help is being provided by the Pentagon and the Veterans Affairs Department.

For some, there are long waits for appointments at the VA or at military posts. For others, the stigma of a mental health disorder keeps them from seeking help.

Paul Rieckhoff, executive director and founder of Iraq and Afghanistan Veterans of America, says that although suicides among troops returning from the war is a significant problem, the scope is unknown.

“The problem that we face right now is that there’s no method to track veterans coming home,” said Rieckhoff, who served in Iraq as a platoon leader in the first year of the war. “There’s no system. There’s no national registry.”

More than four years into the war, the government has little information on suicides among Iraq war veterans.

“We don’t keep that data,” said Karen Fedele, a VA spokeswoman in Washington. “I’m told that somebody here is going to do an analysis, but there just is nothing right now.”

The Defense Department does track suicides, but only among troops in combat operations such as Iraq and Afghanistan and in surrounding areas. Since the war started four years ago, 107 suicides during Iraq operations have been recorded by the Defense Manpower Data Center, which collects data for the Pentagon. That number, however, usually does not include troops who return home from the war zone and then take their lives.

For service members returning from combat, post-deployment health assessments include a questionnaire with queries about mental health. This year, the Pentagon expanded health monitoring for war veterans to include another screening three to six months after combat.

“We’re trying to reach out,” said Maj. Gen. Gale Pollock, the Army’s acting surgeon general. “Will we get to everyone on time? No, I wish we could.”

Pollock said the Army is expanding a program started in January at Fort Bragg, N.C., which aims to lessen the stigma associated with post-traumatic stress disorder. It brings behavioral health staff directly into primary care clinics instead of making soldiers go to a separate mental health facility for help.

Earlier this month, a Pentagon task force warned that the military health care system is overburdened and not sufficient to meet the needs of troops suffering from PTSD and other psychological problems. The panel called for a fundamental shift in treatment to focus on screening and prevention instead of relying on troops to come forward on their own.

Shortcomings in mental health care were also identified in a recent report by the VA’s inspector general. It found that several of the agency’s hospitals and clinics lacked properly trained workers and had inadequate screening for mental health problems. It said this put Iraq veterans at increased risk of suicide.

Floyd “Shad” Meshad, president and founder of the California-based National Veterans Foundation, has no doubt that military suicides are a growing problem. He said he receives 2 to 3 calls each week from Iraq veterans contemplating suicide — or from their families.

A Vietnam veteran who has counseled other vets for more than 30 years, Meshad runs a toll-free support line based in Los Angeles. He was asked recently to help train counselors at the Suicide Prevention Center in Los Angeles, where a spike in calls from veterans has been reported.

One of the biggest challenges for troubled vets is the stigma of a mental health disorder, said Meshad. “It’s very, very hard for you to reach out and say ‘I’m hurting.’ It’s hard for men to do it, but particularly (for) a soldier who’s endured life and death situations.”

Kim Ruocco of Newbury, Mass., said her husband, John, was a role model for the young Marines he led in war. He worried about the ramifications of seeking help, personally and professionally.

“He felt like that was the end of everything for him,” Kim Ruocco recalls. “He felt like his Marines would, you know, be let down.”

Ruocco ended his life in February 2005, a few weeks before he was to redeploy to Iraq.

Joshua Omvig, 22, a member of the Army Reserve from Grundy Center, Iowa, also took his own life. In December 2005, he shot himself in front of his mother after an 11-month tour in Iraq.

His parents, Ellen and Randy Omvig, say Joshua wouldn’t talk much about Iraq. They tried to get him help, but he worried that it would hurt his career if the Army found out, said his father.

Randy Omvig says the military and VA need to offer better readjustment counseling. There should be teams of health professionals, he said, who come to the base to talk to the troops in a comfortable setting with their comrades.

“It’s like you and I going out on that interstate and driving 65 miles an hour and then all of a sudden deciding to put it in first gear,” Omvig said. “What happens? Does the car handle it very well? Some will handle it, a lot of them are going to have problems.”

The Senate Committee on Veterans’ Affairs is considering a bill named for Joshua Omvig. It directs the VA to develop a suicide prevention program for veterans suffering from PTSD and other depression issues. It unanimously passed the House in March.

The VA declined to comment about the bill or its requirements.

For some troops returning from Iraq, the wait for care is too long.

Army Capt. Michael Pelkey, who suffered from night sweats, anxiety, headaches and exhaustion when he returned, sought help at Fort Sill, Okla. His wife, Stefanie, said the mental health facility there was understaffed and Michael was told he’d have to wait up to two months for an appointment.

He went off-base in Nov. 2004 and a civilian counselor diagnosed him with post-traumatic stress disorder. His wife says it came too late. He shot himself in the living room a week later.

Jonathan Schulze of New Prague, Minn., also tried to get help after he came home from Iraq. His parents say he asked to be admitted to a VA hospital but was turned away twice. The VA disputes that. The Marine hanged himself in January at the age of 25.

For Marine Jeffrey Lucey, the return home from Iraq was followed by months of emotional and mental torment, said his father, Kevin Lucey. The 23-year-old killed himself in June 2004 at his parents’ home in Belchertown, Mass. His father found him dead in the basement, hanging by a garden hose.

There are more. Robert Decouteaux, Douglas Barber, William Howell, Andre McDaniel, Jeremy Wilson, Robert Hunt, Chris Dana and David Guindon — all men who served in the Iraq war and killed themselves after coming home.

Veterans groups worry there will be more given the rise in cases of post-traumatic stress disorder.

PTSD disability claims to the VA increased almost 80 percent over five years — from 120,265 in 1999 to 215,871 in 2004. Benefit payments jumped nearly 150 percent, from $1.72 billion to $4.28 billion in the same period, according to a report this month from a committee of the Institute of Medicine and the National Research Council.

Marine Cpl. Cloy Richards says he experienced symptoms of PTSD after two tours in Iraq. “I was depressed all the time. I just hated myself,” he recalled.

He couldn’t sleep. He didn’t want to be around other people. One day, he said, he put a gun in his mouth and then decided to call his mom to say goodbye. She talked him down.

Richards, 23, said he had trouble getting appointments at his local VA in Missouri, but eventually received counseling from a Vietnam veteran who taught him how to better cope with his anger and anxiety. Richards has become an outspoken critic of the war, joining Iraq Veterans Against the War.

He wants to be happy, he says, but still feels troubled.

“My counselor says that comes from guilt,” Richards said. “I feel guilty about being happy since, you know, some of my friends died in Iraq and I’m alive.”